Adoption of Artificial Intelligence-Enabled Robots in Long-Term Care Homes by Health Care Providers: Scoping Review

BACKGROUND

Long-term care (LTC) homes face the challenges of increasing care needs of residents and a shortage of health care providers. Literature suggests that artificial intelligence (AI)-enabled robots may solve such challenges and support person-centered care. There is a dearth of literature exploring the perspectives of health care providers, which are crucial to implementing AI-enabled robots.

OBJECTIVE

This scoping review aims to explore this scant body of literature to answer two questions: (1) what barriers do health care providers perceive in adopting AI-enabled robots in LTC homes? (2) What strategies can be taken to overcome these barriers to the adoption of AI-enabled robots in LTC homes?

METHODS

We are a team consisting of 3 researchers, 2 health care providers, 2 research trainees, and 1 older adult partner with diverse disciplines in nursing, social work, engineering, and medicine. Referring to the Joanna Briggs Institute methodology, our team searched databases (CINAHL, MEDLINE, PsycINFO, Web of Science, ProQuest, and Google Scholar) for peer-reviewed and gray literature, screened the literature, and extracted the data. We analyzed the data as a team. We compared our findings with the Person-Centered Practice Framework and Consolidated Framework for Implementation Research to further our understanding of the findings.

RESULTS

This review includes 33 articles that met the inclusion criteria. We identified three barriers to AI-enabled robot adoption: (1) perceived technical complexity and limitation; (2) negative impact, doubted usefulness, and ethical concerns; and (3) resource limitations. Strategies to mitigate these barriers were also explored: (1) accommodate the various needs of residents and health care providers, (2) increase the understanding of the benefits of using robots, (3) review and overcome the safety issues, and (4) boost interest in the use of robots and provide training.

CONCLUSIONS

Previous literature suggested using AI-enabled robots to resolve the challenges of increasing care needs and staff shortages in LTC. Yet, our findings show that health care providers might not use robots because of different considerations. The implication is that the voices of health care providers need to be included in using robots.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-doi:10.1136/bmjopen-2023-075278.

Socially Assistive Robots for patients with Alzheimer's Disease: A scoping review

BACKGROUND

The most common form of dementia, Alzheimer's Disease (AD), is challenging for both those affected as well as for their care providers, and caregivers. Socially assistive robots (SARs) offer promising supportive care to assist in the complex management associated with AD.

OBJECTIVES

To conduct a scoping review of published articles that proposed, discussed, developed or tested SAR for interacting with AD patients.

METHODS

We performed a scoping review informed by the methodological framework of Arksey and O'Malley and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist for reporting the results. At the identification stage, an information specialist performed a comprehensive search of 8 electronic databases from the date of inception until January 2022 in eight bibliographic databases. The inclusion criteria were all populations who recive or provide care for AD, all interventions using SAR for AD and our outcomes of inteerst were any outcome related to AD patients or care providers or caregivers. All study types published in the English language were included.

RESULTS

After deduplication, 1251 articles were screened. Titles and abstracts screening resulted to 252 articles. Full-text review retained 125 included articles, with 72 focusing on daily life support, 46 on cognitive therapy, and 7 on cognitive assessment.

CONCLUSION

We conducted a comprehensive scoping review emphasizing on the interaction of SAR with AD patients, with a specific focus on daily life support, cognitive assessment, and cognitive therapy. We discussed our findings' pertinence relative to specific populations, interventions, and outcomes of human-SAR interaction on users and identified current knowledge gaps in SARs for AD patients.

A scoping review of the use of intelligent assistive technologies in rehabilitation practice with older adults

PURPOSE

There is growing interest in intelligent assistive technologies (IATs) in the rehabilitation and support of older adults, however, the factors contributing to or preventing their use in practice are not well understood. This study aimed to develop an overview of current knowledge on barriers and facilitators to the use of smart technologies in rehabilitative practice with older adults.

MATERIALS AND METHODS

We undertook a scoping review following guidelines proposed by Arksey and O'Malley (2005) and Levac et al. (2010). A computerised literature search was conducted using the Scopus and Ovid databases, yielding 7995 citations. Of these, 94 studies met inclusion criteria. Analysis of extracted data identified themes which were explored in semi-structured interviews with a purposefully selected sample of seven clinical rehabilitation practitioners (three physical therapists, two occupational therapists, and two speech-language pathologists).

RESULTS

Barriers and facilitators to using these technologies were associated with accessibility, reported effectiveness, usability, patient-centred considerations, and staff considerations.

CONCLUSIONS

Collaborative efforts of policy-makers, researchers, manufacturers, rehabilitation professionals, and older persons are needed to improve the design of technologies, develop appropriate funding and reimbursement strategies, and minimise barriers to their appropriate use to support independence and quality of life. Any strategies to improve upon barriers to prescribing smart technologies for older people should leverage the expertise of rehabilitation professionals operating at the interface between older people; their health/mobility; their families; and technology-based solutions.

What helps, what hinders?-Focus group findings on barriers and facilitators for mobile service robot use in a psychosocial group therapy for people with dementia

Introduction

Many countries are facing a shortage of healthcare workers. Furthermore, healthcare workers are experiencing many stressors, resulting in psychological issues, impaired health, and increased intentions to leave the workplace. In recent years, different technologies have been implemented to lighten workload on healthcare workers, such as electronic patient files. Robotic solutions are still rather uncommon. To help with acceptance and actual use of robots their functionalities should correspond to the users' needs.

Method

In the pilot study Care4All-Initial, we developed and field-tested applications for a mobile service robot in a psychosocial, multimodal group therapy for people with dementia. To guide the process and assess possible facilitators and barriers, we conducted a reoccurring focus group including people with dementia, therapists, professional caregivers as well as researchers from different disciplines with a user-centered design approach. The focus group suggested and reviewed applications and discussed ethical implications. We recorded the focus group discussions in writing and used content analysis.

Results

The focus group discussed 15 different topics regarding ethical concerns that we used as a framework for the research project: Ethical facilitators were respect for the autonomy of the people with dementia and their proxies regarding participating and data sharing. Furthermore, the robot had to be useful for the therapists and attendees. Ethical barriers were the deception and possible harm of the people with dementia or therapists. The focus group suggested 32 different applications. We implemented 13 applications that centered on the robot interacting with the people with dementia and lightening the workload off the therapists. The implemented applications were facilitated through utilizing existing hard- and software and building on applications. Barriers to implementation were due to hardware, software, or applications not fitting the scope of the project.

Discussion

To prevent barriers of robot employment in a group therapy for people with dementia, the robot's applications have to be developed sufficiently for a flawless and safe use, the use of the robot should not cause irritation or agitation, but rather be meaningful and useful to its users. To facilitate the development sufficient time, money, expertise and planning is essential.

Humanoid robots for assisting people with physical disabilities in activities of daily living: a scoping review

The aim of this scoping review was to gather, summarize, and map the knowledge of peoples' experiences on humanoid robots, capable of assisting people with activities of daily living. The review was guided by the framework of Joanna Briggs Institute and PRISMA-ScR. We found 44 papers describing nine robots that could assist with a variety of tasks listed in the International Classification of Functioning, Disability, and Health. The mixed population experienced little or no anxiety toward the robots, and most accepted the robots' ability to monitor for safety reasons. Some participants disliked the robots' large size and slow movements. Most of the participants found the robots easy to use. They wanted improvements in the robots' functionality and the ability to personalize services. Several of the participants found the services interesting and useful, but not for themselves. The experiences of humanoid robotic assistance showed an insufficient level of technical readiness for assisting in physical assistance, a lack of personalization and readiness for use in home settings. The practical relevance of these findings lies in guiding future research and development toward a more individualized approach focusing on user needs and experiences to enhance the efficacy and integration of humanoid robots in health-care.

When a notification at the right time is not enough: the reminding process for socially assistive robots in institutional care

Reminding is often identified as a central function of socially assistive robots in the healthcare sector. The robotic reminders are supposed to help people with memory impairments to remember to take their medicine, to drink and eat, or to attend appointments. Such standalone reminding technologies can, however, be too demanding for people with memory injuries. In a co-creation process, we developed an individual reminder robot together with a person with traumatic brain injury and her care personnel. During this process, we learned that while current research describe reminding as a prototypical task for socially assistive robots, there is no clear definition of what constitutes a reminder nor that it is based on complex sequences of interactions that evolve over time and space, across different actions, actors and technologies. Based on our data from the co-creation process and the first deployment, we argue for a shift towards a sequential and socially distributed character of reminding. Understanding socially assistive robots as rehabilitative tools for people with memory impairment, they need to be reconsidered as interconnected elements in institutional care practices instead of isolated events for the remindee.

Care-receivers with physical disabilities' perceptions on having humanoid assistive robots as assistants: a qualitative study

BACKGROUND

People with physical disabilities due to disease or injury face barriers to their daily activities and participation in society. Many depend on formal or informal caregivers for assistance to live independently. However, future healthcare challenges due to demographic changes threaten access to home care and assistants. Assistive technologies, such as robots for physical assistance, can support the independence and autonomy of people with physical disabilities. This study explore Norwegian care-receivers' perceptions of using robot assistance in their homes, including preferences for tasks acceptable or unacceptable for robot assistance and the underlying reasons.

METHOD

Purposive sampling was employed to recruit 18 participants, aged between 18 and 77 years, with differences in physical function including diagnoses such as stroke, spinal cord injury, amputations, and muscular dystrophy. Qualitative data were gathered through four focus group interviews wherein participants watched videos featuring a humanoid assistive robot, EVEr3. The collected data underwent analysis using reflexive thematic analysis.

RESULTS

Three themes with associated sub-themes were constructed: (a) How a robot could assist in daily life, (b) The robot's appearance and functionality, and (c) Concerns about having a robot as an assistant. The participants welcomed the idea of a future robotic assistant in areas that may contribute to an increased feeling of independence and autonomy.

CONCLUSION

A robot assisting in activities of daily living would need to be individually customized to meet the needs of each user in terms of which tasks to assist with, how to assist in these defined tasks, and how it is controlled.

Assimilation of socially assistive robots by older adults: an interplay of uses, constraints and outcomes

By supporting autonomy, aging in place, and wellbeing in later life, Socially Assistive Robots are expected to help humanity face the challenges posed by the rapid aging of the world's population. For the successful acceptance and assimilation of SARs by older adults, it is necessary to understand the factors affecting their Quality Evaluations Previous studies examining Human-Robot Interaction in later life indicated that three aspects shape older adults' overall QEs of robots: uses, constraints, and outcomes. However, studies were usually limited in duration, focused on acceptance rather than assimilation, and typically explored only one aspect of the interaction. In the present study, we examined uses, constraints, and outcomes simultaneously and over a long period. Nineteen community-dwelling older adults aged 75-97 were given a SAR for physical training for 6 weeks. Their experiences were documented via in-depth interviews conducted before and after the study period, short weekly telephone surveys, and reports produced by the robots. Analysis revealed two distinct groups: (A) The 'Fans' - participants who enjoyed using the SAR, attributed added value to it, and experienced a successful assimilation process; and (B) The 'Skeptics' - participants who did not like it, negatively evaluated its use, and experienced a disappointing assimilation process. Despite the vast differences between the groups, both reported more positive evaluations of SARs at the end of the study than before it began. Overall, the results indicated that the process of SARs' assimilation is not homogeneous and provided a profound understanding of the factors shaping older adults' QE of SARs following actual use. Additionally, the findings demonstrated the theoretical and practical usefulness of a holistic approach in researching older SARs users.

Enhancing neurocognitive health, abilities, networks, & community engagement for older adults with cognitive impairments through technology: a scoping review introducing the ENHANCE Center

PURPOSE

Age associated cognitive impairments (CIs) result in difficulties with a wide range of daily activities. As the older adult population increases, so does the importance of understanding and supporting the needs and disabilities of those with CIs. The Enhancing Neurocognitive Health, Abilities, Networks, and Community Engagement (ENHANCE) Centre was established with a focus on developing assistive technology to support the socialisation, transportation, and prospective memory needs of older adults with CIs. The extent to which relevant literature in these domains existed was unknown.

MATERIALS AND METHODS

A scoping review identified existing research meeting the following criteria: participants aged 50+ years classified as having a CI due to mild cognitive impairment (MCI), traumatic brain injury (TBI), or stroke; and a focus on technology-based support for socialisation, transportation, and/or prospective memory activities.

RESULTS

Qualitative and quantitative data are reported from relevant studies. In addition to few studies available, it was common for studies to include 20 or fewer participants. Most assessed technology interactions at one time and few studies examined longitudinal use and benefit. While each paper examined one aspect of user-centred design, no technologies were reported that underwent all stages of the user-centred design process, from needs assessment to iterative design and usability testing, to efficacy trial.

CONCLUSIONS

Gaps highlight notable directions for future research and the important role ENHANCE can play in addressing the needs and disabilities of older adults with CIs. IMPLICATIONS FOR REHABILITATIONAlthough older adults with common cognitive impairments often experience challenges in the domains of socialisation, transportation, and/or prospective memory, few studies exist that examine assistive technology solutions in these domains.Additional research with more robust designs and larger sample sizes is needed to discover and assess assistive technology solutions for the needs and disabilities of older adults with mild cognitive impairment (MCI), traumatic brain injury (TBI), and post-stroke cognitive impairment (PSCI).The ENHANCE Centre will employ a systematic process of needs assessments, user testing, and efficacy tests to develop novel technology solutions to support the needs of older adults with common cognitive impairment.

Digital economy and high-quality development of the healthcare industry

The high-quality development of the healthcare industry is of great significance for improving people's health and promoting the construction of a harmonious society. This paper focuses on the relationship between the development of China's digital economy and the high-quality development of the healthcare industry. Based on the panel data of 30 provinces in China from 2011 to 2020, this paper empirically studies whether the development of the digital economy promotes the high-quality development of the healthcare industry. This study finds that the development of digital economy has significantly promoted the high-quality development of the medical and health industry. The results of this study are still valid after a series of robustness tests including variable substitution, sample adjustment, and endogenous problem mitigation. Heterogeneity analysis shows that the effect of this policy is more significant in the eastern region and southern areas. The results of spatial econometric analysis show that the development of digital economy has obvious spatial spillover effect. The research in this paper can provide reference for developing countries to enhance the development level of digital health industry and improve people's lives.

The perspectives of older adults with mild cognitive impairment and their caregivers on the use of socially assistive robots in healthcare: exploring factors that influence attitude in a pre-implementation stage

BACKGROUND

Due to increasing age and an increasing prevalence rate of neurocognitive disorders such as Mild Cognitive Impairment (MCI) and dementia, independent living may become challenging. The use of socially assistive robots (SARs) is one solution that can enable older adults with cognitive impairment to remain independent. However, at present, there is a lack of knowledge about the attitudes of older adults with MCI and their caregivers towards SARs.

METHODS

This study relies on a constructivist grounded theory approach. Semi-structured interviews were conducted to gain a deeper insight into attitudes of two different stakeholder groups; older adults with MCI and their (in)formal caregivers.

RESULTS

Forty individual semi-structured interviews were conducted with older adults with MCI (N = 30) and (in)formal caregivers (N = 10). Data revealed different perspectives on SARs in healthcare for the involved stakeholders. Two main topics could be derived: (1) perspectives on robot assistance, discussing different viewpoints on the potential value of robots as helpers, and (2) perspectives on implementation, revealing different factors that could affect implementation. Both topics may explain a positive, impartial or negative attitude towards SARs.

CONCLUSIONS

This study identified different factors that should be taken into account when implementing a SAR in the home environment of older adults. Despite the fact that the benefits of SARs are often recognized, many older participants currently seem not ready yet to commit to the use of a SAR.IMPLICATIONS FOR REHABILITATIONThis study explores the attitudes towards a SAR, developed to stimulate and support older adults with Mild Cognitive Impairment (MCI) on a physical, cognitive and social level.The results give a deeper insight into different factors contributing to a (non-) successful implementation of SARs in the home environment of older adults with MCI.

Long-Term Adoption or Abandonment of Smart Technology in the Chinese Elderly Home Care Environment: A Qualitative Research Study

China's rapidly aging population and shortage of care resources have made it difficult for its traditional model to meet the home care needs of the elderly. On this premise, China is implementing home digital health interventions based on smart technology. During implementation, instead of the expected explosion in long-term adoption, there has been a large amount of abandonment. But so far, the relationship between service experience and these behaviors has been ignored. This study aims to explore the reasons for the long-term adoption or abandonment behaviors of technology by elders in the home care environment. A qualitative study was conducted based on Golant's framework of smart technology adoption behaviors among elders. Semi-structured interviews were conducted with 26 elders who are long-term or former users of smart technology in a home care environment, and data from the interviews were analyzed using directed content analysis. This study identified three themes that influence elders' adoption behaviors of smart technology in the home care environment, including immediate effectiveness, long-term usability, and possible collateral damage. The findings indicated that the experience of the elders is the key point that affects long-term adoption behavior. For more elders to use smart technology in the home care environment, it is necessary for the government, technology developers, and nursing institutions to further reform the existing system.

Socially Assistive Humanoid Robots: Effects on Depression and Health-Related Quality of Life among Low-Income, Socially Isolated Older Adults in South Korea

Using a mixed-method study design, we examined the effects of a socially assistive humanoid robot (SAHR), called Hyodol, on depressive symptoms and health-related quality of life (HRQOL) of low-income, socially isolated older adults (N = 180). Quantitative outcomes were assessed at baseline (before Hyodol deployment) and at 3 and 6 months after baseline. Results showed reduced depressive symptoms and improved HRQOL at 3 months; however, these positive effects did not extend to 6 months. Ten focus group participants perceived Hyodol to be a valuable companion especially during the COVID outbreak. These results suggest that while Hyodol may have provided companionship for some low-income, socially isolated older adults during home confinement, its effects on depression and HRQOL were limited. Further research is needed to assess long-term effects of SAHRs as appropriate tools for reducing social isolation and improving behavioral health among community-dwelling older adults.

Integrating Social Assistive Robots, IoT, Virtual Communities and Smart Objects to Assist at-Home Independently Living Elders: the MoveCare Project

The integration of Ambient Assisted Living (AAL) frameworks with Socially Assistive Robots (SARs) has proven useful for monitoring and assisting older adults in their own home. However, the difficulties associated with long-term deployments in real-world complex environments are still highly under-explored. In this work, we first present the MoveCare system, an unobtrusive platform that, through the integration of a SAR into an AAL framework, aimed to monitor, assist and provide social, cognitive, and physical stimulation in the own houses of elders living alone and at risk of falling into frailty. We then focus on the evaluation and analysis of a long-term pilot campaign of more than 300 weeks of usages. We evaluated the system's acceptability and feasibility through various questionnaires and empirically assessed the impact of the presence of an assistive robot by deploying the system with and without it. Our results provide strong empirical evidence that Socially Assistive Robots integrated with monitoring and stimulation platforms can be successfully used for long-term support to older adults. We describe how the robot's presence significantly incentivised the use of the system, but slightly lowered the system's overall acceptability. Finally, we emphasise that real-world long-term deployment of SARs introduces a significant technical, organisational, and logistical overhead that should not be neglected nor underestimated in the pursuit of long-term robust systems. We hope that the findings and lessons learned from our work can bring value towards future long-term real-world and widespread use of SARs.

Digital Engagement of Older Adults: Scoping Review

BACKGROUND

Digital technologies facilitate everyday life, social connectedness, aging at home, well-being, and dignified care. However, older adults are disproportionately excluded from these benefits. Equal digital opportunities, access, and meaningful engagement require an understanding of older adults' experience across different stages of the technological engagement life cycle from nonuse and initial adoption to sustained use, factors influencing their decisions, and how the experience changes over time.

OBJECTIVE

Our objectives were to identify the extent and breadth of existing literature on older adults' perspective on digital engagement and summarize the barriers to and facilitators for technological nonuse, initial adoption, and sustained digital technology engagement.

METHODS

We used the Arksey and O'Malley framework for the scoping review process. We searched MEDLINE, PsycINFO, CINAHL, Web of Science, and ACM digital library for primary studies published between 2005 and 2021. The inclusion and exclusion criteria were developed based on the Joanna Briggs Institute (participants, content, and context) framework. Studies that investigated the digital engagement experience as well as barriers to and facilitators of older adults' digital technology engagement were included. The characteristics of the study, types of digital technology, and digital engagement levels were analyzed descriptively. Content analysis was used to generate tentative elements using a congruent theme, and barriers and facilitators were mapped over the capability, opportunity, and motivation behavior change model (COM-B) and the theoretical domain framework. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews).

RESULTS

In total, 96 publications were eligible for the final charting and synthesis. Most of the studies were published over the past 5 years, investigated the initial adoption stage of digital engagement, and focused on everyday technologies. The most cited barriers and facilitators across the engagement stages from each COM-B component were capability (eg, physical and psychological changes and lack of skill), opportunity (eg, technological features, environmental context, and resources), and motivation (eg, optimism from perceived usefulness and beliefs about capability).

CONCLUSIONS

The COM-B model and theoretical domain framework provide a guide for identifying multiple and intertwined barriers and facilitators at each stage of digital engagement. There are limited studies looking into the whole spectrum of older adults' digital technology experience; in particular, studies on technological nonuse and sustained use stages are rare. Future research and practice should focus on tailored interventions accounting for the barriers to older adults' digital engagement and addressing capabilities, motivation, and opportunities; affordable, usable, and useful digital technologies, which address the changes and capability requirements of older adults and are cocreated with a value framework; and lifelong learning and empowerment to develop older adults' knowledge and skills to cope with digital technology development.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/25616.

Designing Robots for Aging: Wisdom as a Critical Lens

Although the concept of wisdom is ancient, empirical research on it has only recently received attention in gerontology. This coincides with a critical turn away from a deficit model of aging, viewing aging as a series of losses, toward a more supportive and developmental model. This paper draws on this recent work to consider how wisdom can be a critical lens for HRI researchers and other technology design researchers to pay more attention to the coping strategies that older adults accumulated throughout their lives. We engaged in a six-month collaborative design process with community-dwelling older adults. The contributions of this paper are twofold. First, we found that wisdom as a design concept helps researchers to critically examine how they define knowledge. Wisdom as an accumulation of experiential knowledge of older adults helps researchers rethink the definition of knowledge—valuing computational and technological knowledge—in the field of HRI. Second, wisdom leads researchers to the past experiences of older adults. Although past experiences are as important as current experiences, they are not actively considered in robot design studies for older adults. We hope wisdom as a critical lens could allow researchers to integrate the invisible aspects of older adults’ aging experiences into the existing practices of designing robots for aging users.

Systematic Review of Computer Vision Semantic Analysis in Socially Assistive Robotics

The simultaneous surges in the research on socially assistive robotics and that on computer vision can be seen as a result of the shifting and increasing necessities of our global population, especially towards social care with the expanding population in need of socially assistive robotics. The merging of these fields creates demand for more complex and autonomous solutions, often struggling with the lack of contextual understanding of tasks that semantic analysis can provide and hardware limitations. Solving those issues can provide more comfortable and safer environments for the individuals in most need. This work aimed to understand the current scope of science in the merging fields of computer vision and semantic analysis in lightweight models for robotic assistance. Therefore, we present a systematic review of visual semantics works concerned with assistive robotics. Furthermore, we discuss the trends and possible research gaps in those fields. We detail our research protocol, present the state of the art and future trends, and answer five pertinent research questions. Out of 459 articles, 22 works matching the defined scope were selected, rated in 8 quality criteria relevant to our search, and discussed in depth. Our results point to an emerging field of research with challenging gaps to be explored by the academic community. Data on database study collection, year of publishing, and the discussion of methods and datasets are displayed. We observe that the current methods regarding visual semantic analysis show two main trends. At first, there is an abstraction of contextual data to enable an automated understanding of tasks. We also observed a clearer formalization of model compaction metrics.

Assistive technology acceptance for visually impaired individuals: a case study of students in Saudi Arabia

Assistive technology (AT) helps students who suffer from visual impairments to achieve their study goals; however, AT's adoption in Saudi universities is not yet explored. This paper adopts and then extends the Unified Theory of Acceptance and Use of Technology (UTAUT) to incorporate factors influencing the AT's acceptance based on a designed survey. The survey data was analyzed using Structural Equational Modelling (SEM) with the Partial Least Squares (PLS) technique. The results showed that the factors influencing technology acceptance in this context differed from those previously found to influence acceptance in other contexts. The differences were further studied using post-interview, which shows that the differences are related to limited awareness of visual disability and AT and psychological sensitivity of disabled users in Saudi culture. Moreover, this study provides a list of recommendations for overcoming barriers that limit the acceptance of assistive techniques by Saudi students with visual disabilities. This work's results provide recommendations for the Saudi government and administrators concerning access to assistive technology in universities and facilitate access to other technologies and other contexts.

Novelty Experience in Prolonged Interaction: A Qualitative Study of Socially-Isolated College Students' In-Home Use of a Robot Companion Animal

Social distancing policies such as limits on public gatherings and contact with others were utilized around the world to slow the spread of COVID-19. Yet, decreased social interactions may also threaten people's well-being. In this project, we sought to understand novelty-relevant experiences surrounding in-home companion robot pets for adults that were living in some degree of social isolation due to the COVID-19 pandemic. After 6-weeks of participants living with the robot companion, we conducted semi-structured interviews (N = 9) and six themes emerged from our iterative analysis (expectations versus reality, ontological comparisons, interactions, third-party influence, identity, and comfort). Findings suggest that novelty is a complex phenomenon consisting of various elements (i.e., imagined novelty, technology novelty, and relational novelty). Each component influences the user's experience. Our findings also suggest that our understanding of novelty as a nonlinear resource may hold important implications for how we view human-robot relationships beyond initial encounters.

Older Adults' Loneliness, Social Isolation, and Physical Information and Communication Technology in the Era of Ambient Assisted Living: A Systematic Literature Review

BACKGROUND

Loneliness and social isolation can have severe effects on human health and well-being. Partial solutions to combat these circumstances in demographically aging societies have been sought from the field of information and communication technology (ICT).

OBJECTIVE

This systematic literature review investigates the research conducted on older adults' loneliness and social isolation, and physical ICTs, namely robots, wearables, and smart homes, in the era of ambient assisted living (AAL). The aim is to gain insight into how technology can help overcome loneliness and social isolation other than by fostering social communication with people and what the main open-ended challenges according to the reviewed studies are.

METHODS

The data were collected from 7 bibliographic databases. A preliminary search resulted in 1271 entries that were screened based on predefined inclusion criteria. The characteristics of the selected studies were coded, and the results were summarized to answer our research questions.

RESULTS

The final data set consisted of 23 empirical studies. We found out that ICT solutions such as smart homes can help detect and predict loneliness and social isolation, and technologies such as robotic pets and some other social robots can help alleviate loneliness to some extent. The main open-ended challenges across studies relate to the need for more robust study samples and study designs. Further, the reviewed studies report technology- and topic-specific open-ended challenges.

CONCLUSIONS

Technology can help assess older adults' loneliness and social isolation, and alleviate loneliness without direct interaction with other people. The results are highly relevant in the COVID-19 era, where various social restrictions have been introduced all over the world, and the amount of research literature in this regard has increased recently.

Patients' Perceptions Toward Human-Artificial Intelligence Interaction in Health Care: Experimental Study

Background

It is believed that artificial intelligence (AI) will be an integral part of health care services in the near future and will be incorporated into several aspects of clinical care such as prognosis, diagnostics, and care planning. Thus, many technology companies have invested in producing AI clinical applications. Patients are one of the most important beneficiaries who potentially interact with these technologies and applications; thus, patients’ perceptions may affect the widespread use of clinical AI. Patients should be ensured that AI clinical applications will not harm them, and that they will instead benefit from using AI technology for health care purposes. Although human-AI interaction can enhance health care outcomes, possible dimensions of concerns and risks should be addressed before its integration with routine clinical care.

Objective

The main objective of this study was to examine how potential users (patients) perceive the benefits, risks, and use of AI clinical applications for their health care purposes and how their perceptions may be different if faced with three health care service encounter scenarios.

Methods

We designed a 2×3 experiment that crossed a type of health condition (ie, acute or chronic) with three different types of clinical encounters between patients and physicians (ie, AI clinical applications as substituting technology, AI clinical applications as augmenting technology, and no AI as a traditional in-person visit). We used an online survey to collect data from 634 individuals in the United States.

Results

The interactions between the types of health care service encounters and health conditions significantly influenced individuals’ perceptions of privacy concerns, trust issues, communication barriers, concerns about transparency in regulatory standards, liability risks, benefits, and intention to use across the six scenarios. We found no significant differences among scenarios regarding perceptions of performance risk and social biases.

Conclusions

The results imply that incompatibility with instrumental, technical, ethical, or regulatory values can be a reason for rejecting AI applications in health care. Thus, there are still various risks associated with implementing AI applications in diagnostics and treatment recommendations for patients with both acute and chronic illnesses. The concerns are also evident if the AI applications are used as a recommendation system under physician experience, wisdom, and control. Prior to the widespread rollout of AI, more studies are needed to identify the challenges that may raise concerns for implementing and using AI applications. This study could provide researchers and managers with critical insights into the determinants of individuals’ intention to use AI clinical applications. Regulatory agencies should establish normative standards and evaluation guidelines for implementing AI in health care in cooperation with health care institutions. Regular audits and ongoing monitoring and reporting systems can be used to continuously evaluate the safety, quality, transparency, and ethical factors of AI clinical applications.

Companion robots for older adults: Rodgers' evolutionary concept analysis approach

This study aims to analyze the concept of companion robots for older adults from the perspective of nursing. This study employed a concept analysis. The literature from July 2011 to June 2021 was sought from databases using specific keywords. Any quantitative or qualitative study published in English or Korean focusing on companion robots for older adults was included in the study. Rodgers' evolutionary concept analysis was used to clarify the antecedents, attributes, and consequences. Seventy-five eligible articles were studied. The findings were categorized into antecedents, attributes, and consequences. Companion robot antecedents were classified into individual factors, attitude toward robots, and caregiver and social factors. The defining attributes included human-robot interaction, function, features, structure, cost, and management of the robot being a companion. Consequences were categorized into user, caregiver, and health related. Companion robots are designed to enhance well-being, quality of life, and independence by providing service and companionship and assisting daily life. This mainly includes cognitive and social support, mobility support, relaxation, health monitoring, and self-care support through human-robot interaction. The attributes, antecedents, and consequences of companion robots identified in this study can inform future decision making and interventions by caregivers for aging in place.

Acceptability of Socially Assistive Robots Among Cognitively Intact Older Adults: An Integrative Review

An aging population and technology are two rapidly evolving phenomena occurring simultaneously worldwide. To examine the literature on the acceptability of socially assistive robots (SAR) among cognitively intact older adults, an integrative review of the literature was performed using Whittemore and Knafl's approach. Electronic databases searched included CINAHL, PubMed, and the Cochrane Library. Review was limited to peer-reviewed articles published between 2013 and 2019, in or translated into English language, and included evaluation of the robot within a social context in older adults aged ≥60 years with intact cognition. A total of five articles were included in the review. There were 125 male and female participants in all studies, and the mean age of participants ranged from 66.3 to 77.1 years. The robots studied varied in design and functionality. Findings showed older adults who are cognitively intact find SAR easy to use and useful, suggesting acceptability of SAR. [Journal of Gerontological Nursing, 47(9), 49-54.].

Artificial Vision Algorithms for Socially Assistive Robot Applications: A Review of the Literature

Today, computer vision algorithms are very important for different fields and applications, such as closed-circuit television security, health status monitoring, and recognizing a specific person or object and robotics. Regarding this topic, the present paper deals with a recent review of the literature on computer vision algorithms (recognition and tracking of faces, bodies, and objects) oriented towards socially assistive robot applications. The performance, frames per second (FPS) processing speed, and hardware implemented to run the algorithms are highlighted by comparing the available solutions. Moreover, this paper provides general information for researchers interested in knowing which vision algorithms are available, enabling them to select the one that is most suitable to include in their robotic system applications.

Attitudes of the elderly living independently towards the use of robots to assist with activities of daily living

BACKGROUND

Robots are gaining attention as a potential solution to aging.

OBJECTIVE

The purpose of this study is to explore the attitude of robot assistance in Activities of Daily Living (ADLs) among elderly people living independently.

METHODS

The one-on-one interview, buddy robot video and questionnaire survey were used to analyze mean, median, range, and the test results of non-parametric statistical methods such as Wilcoxon sign-rank test statistic and one-sample Wilcoxon sign-rank test statistic, so as to explore the attitude of the elderly living independently towards robot-assisted ADLs and the acceptance of the use of robots in 32 ADLs.

RESULTS

The results showed that there were significant differences in the attitudes, usability and ease of use of elderly people towards robot assistance before and after watching the Buddy Robot video and they had a more positive attitude after watching the video. According to the results, the elderly was more receptive to the use of robots in activities such as "reminding to carry objects" and "reminding to take medicine", while they were less receptive to the use of robots in the group or private activities such as "playing mahjong" and "taking a bath".

CONCLUSIONS

The results showed that the elderly had a positive attitude towards the use of robot-assisted ADLs, and there were differences in the acceptance of robot-assisted ADLs. The results are helpful to understand the assistance needs and attitudes of the elderly, and provide a reference for the design of assistive robots that meet user needs, and ultimately improve the ability of the elderly to live independently at home.

Perspectives on assistive technology among older Norwegian adults receiving community health services

INTRODUCTION

The western world is seeking increased implementation of assistive technology (AT) to meet the challenges of an ageing population. The objective of this study is to explore perspectives on AT use among home-dwelling older adults with or without cognitive impairment.

METHODS

This study combines findings from a cross-sectional study with a questionnaire package (n = 83) and from qualitative individual interviews (n = 7) and is part of a larger study, the Assisted Living Project. Combining methods promotes complementary inquiries into a phenomenon.

RESULTS

The participants already use ATs: TVs, social alarms, mobile phones, stove timers, electronic medical dispensers, PCs and tablet computers. They were both optimistic and skeptical of AT, and expressed different perspectives and expressed different perspectives on ATs in relation to usability, privacy and fear of losing personal face-to-face care.

CONCLUSIONS

This study reveals that older adults' perspectives on AT are multifaceted and complex, and can partly be explained by the interacting factors in the HAAT model: person, technology, environment, and context. Further exploration in relation to older adults with health challenges, as well as ethical perspectives on AT implementation, is required for this group.

TRIAL REGISTRATION NUMBER

The Norwegian Research Council, Number 47996, funds the Assisted Living Project (ALP).IMPLICATIONS FOR REHABILITATIONThe study was useful in order to inform the health care services about older adults "perspectives on assistive technology".This study reveals the complexity of understanding perspectives towards and the use of assistive technology among older adults with or without cognitive impairment.This study contributes to the understanding of the interactions between the four components: humans, activities, technology and the context.

Dignity, Autonomy, and Style of Company: Dimensions Older Adults Consider for Robot Companions

Research into companion robots for older adults, including those who are socially isolated and lonely, continues to grow. Although some insight into older adults' preferences for various robotic types and functionality is emerging, we lack research examining how these robots fulfil or challenge a range of values and aspirations individuals have in later life. This study examines the attitudes and perspectives of 16 older adults (aged 65+) living independently but alone in their own homes, who were interviewed and shown videos depicting three distinctive companion robots: a talking assistant; a roving toylike vehicle; and a robotic dog. This approach illuminated values, preferences, and needs amongst older people that are vital for understanding the potential of companion robots. In comparing the robots, participants expressed concerns about the impact of different companion robots on their abilities and skills, their sense of autonomy and control over their lives, and the maintenance of several kinds of dignity. These results inform user-centered design and use of companion robots for older people living alone and independently.

Older adults' experiences with and perceptions of the use of socially assistive robots in aged care: A systematic review of quantitative evidence

BACKGROUND

Socially assistive robots (SARs) are created to meet challenges of the global increase of older adults. SARs are autonomous embodied technologies, equipped with auditory and visual faculties, enabling them to interact with users while performing assistive roles. Despite studies focusing on older adults' experiences with and perceptions of SARs, it remains unclear what these encompass.

OBJECTIVE

To gain insight into common aspects of older adults' experiences with and perceptions of SAR use in aged care, the relevant quantitative research literature was reviewed and synthesized.

METHODS

Six electronic databases were searched using detailed search strings. Applying pre-specified inclusion and exclusion criteria resulted in 23 articles to be included. Full texts were analyzed thematically, and graphs were developed to facilitate comparisons.

RESULTS

Six main themes related to older adults' experiences with and perceptions of SAR use were identified: (1) general attitudes toward SARs, (2) feelings about SARs, (3) perceived usefulness and perceived ease of use of SARs, (4) intention to use SARs, (5) tasks of SARs, (6) SARs' appearances. Ethical issues linked to SARs were barely described in the studies.

CONCLUSION

Older adults are relatively open-minded about SARs, generally feeling comfortable with at least some aspects of them, and intend to use SARs in the future, especially for physical assistive functions. Thus, SARs may meet some of older ones' needs. Although the quantitative evidence contributes to gaining insight in older adults' experiences with and perceptions of SARs, social contextualization is necessary to understand their full meaning.

Why do older people love and hate assistive technology? ‒ an emotional experience perspective

Assistive technology is increasingly valued to support older people with functional decline and disabilities. Inspired by classical theories on technology acceptance, emotional experience, and psychological needs, this study aimed to better understand the use of assistive technology by older people. Qualitative semi-structured interviews were conducted with 50 community-dwelling older adults in Hong Kong (mean age = 67.47, standard deviation = 7.96). Thematic analysis was used to generate themes. Positive and negative emotional experiences emerged as two themes. The theme of positive emotional experiences is associated with enhanced security, independence, and relativeness. However, assistive technology may also produce anxiety, frustration, stigma, isolation, and risks that induce negative emotional experiences. These findings indicate that older users' emotional and psychological concerns should be addressed and reflected in the process of assistive technology product design and implementation. Practitioner summary: To enhance the well-being of older people through the application of assistive technology, it is necessary to maximise autonomy or independence, enhance social relativeness, and lift self-competence to evoke positive emotional experiences.

The Perceptions of People with Dementia and Key Stakeholders Regarding the Use and Impact of the Social Robot MARIO

People with dementia often experience loneliness and social isolation. This can result in increased cognitive decline which, in turn, has a negative impact on quality of life. This paper explores the use of the social robot, MARIO, with older people living with dementia as a way of addressing these issues. A descriptive qualitative study was conducted to explore the perceptions and experiences of the use and impact of MARIO. The research took place in the UK, Italy and Ireland. Semi-structured interviews were held in each location with people with dementia (n = 38), relatives/carers (n = 28), formal carers (n = 28) and managers (n = 13). The data was analyzed using qualitative content analysis. The findings revealed that despite challenges in relation to voice recognition and the practicalities of conducting research involving robots in real-life settings, most participants were positive about MARIO. Through the robot's user-led design and personalized applications, MARIO provided a point of interest, social activities, and cognitive engagement increased. However, some formal carers and managers voiced concern that robots might replace care staff.

“THIS ISN’T ME!”: The Role of Age-Related Self- and User Images for Robot Acceptance by Elders

Although companion-type robots are already commercially available, little interest has been taken in identifying reasons for inter-individual differences in their acceptance. Elders’ age-related perceptions of both their own self (self-image) and of the general older robot user (user image) could play a relevant role in this context. Since little is known to date about elders’ companion-type robot user image, it is one aim of this study to investigate its age-related facets, concentrating on possibly stigmatizing perceptions of elder robot users. The study also addresses the association between elders’ age-related self-image and robot acceptance: Is the association independent of the user image or not? To investigate these research questions, N = 28 adults aged 63 years and older were introduced to the companion-type robot Pleo. Afterwards, several markers of robot acceptance were assessed. Actual and ideal self- and subjective robot user image were assessed by a study-specific semantic differential on the stereotype dimensions of warmth and competence. Results show that participants tended to stigmatize elder robot users. The self-images were not directly related to robot acceptance, but affected it in the context of the user image. A higher fit between self- and user image was associated with higher perceived usefulness, social acceptance, and intention to use the robot. To conclude, elders’ subjective interpretations of new technologies play a relevant role for their acceptance. Together with elders’ individual self-images, they need to be considered in both robot development and implementation. Future research should consider that associations between user characteristics and robot acceptance by elders can be complex and easily overlooked.

Impacts of a Care Robotics Project on Finnish Home Care Workers' Attitudes towards Robots

Technological advances in elderly care have been rapid, and the introduction of robots in care will be a topical issue in the near future. There has been little research into the possibility of influencing care workers’ attitudes towards robots by project activities, and how to make the change easier for work communities. This study focuses on a robotics project that took place in elderly and home care services in one municipality in Finland (total of 45 care workers). During the project, four robotics workshops and one extended pilot session were implemented. The study follows quasi-experimental settings, and it included two measurements (before and after project activities) and a control group, but no randomization. The data were collected by questionnaires and were analyzed statistically. The project under study brought about minor positive changes in home care workers’ attitudes towards the usefulness of care robots. In the final measurement, the difference between the test group and the control group was significant in the two dimensions of positive attitudes. The research supports the hypothesis that project activities can be used to influence home care workers’ attitudes towards robots. This can also facilitate the introduction of care robots in home care services. However, the construction of a technology-positive care culture is a long-term process, which requires training and development, technological development and strong strategic management at various levels.

Learning-Enabled Robotic Assistive Support: Understanding Older Adult Opinions and Comparing Them to Younger Adult Opinions

Background

As older adults age, they may require assistance completing activities of daily living (ADLs). Robotic assistance can offset healthcare costs and allow older adults to preserve their autonomy. Younger adults are often involved in the design and purchase of these robotic technologies, and must take into account the needs and expectations of the target population (i.e., older adults) to create a robot that the end-user will adopt.

Research Aim/Questions

This study evaluated the opinions of both younger and older adults regarding the design and performance of the Robot Activity Support (RAS) system. It is important to understand points of agreement and divergence between these populations' perspectives so that effective robotic aids are created for older adults.

Methods

Fifty-two younger and older adults completed three scripted tasks with the RAS robot in a smart home environment. Each participant made task errors to cue the robot to offer help via three prompt modalities (guide to the object, video of forgotten step, and video of the full task). After interacting with the robot, participants completed questionnaires to evaluate their opinions of and satisfaction with the robot.

Results

There were no differences between younger and older adults' perceptions of the robot across a variety of factors (e.g., likability, cognitive demand), with both age groups expressing generally neutral opinions. Both groups rated the Full Video prompt as least helpful, effective, and liked. Participants recommended the robot's response accuracy, movement speed, alerting style and system flexibility be improved. Younger adults overestimated how much older adults would want a robot like this.

Conclusions

This study underscores the importance of testing technology with the end-user, as older adults were less interested in having a similar robot in their home than younger counterparts expected. Future studies will show if older adults' opinions can be improved after making the recommended changes.

Ethical perceptions towards real-world use of companion robots with older people and people with dementia: survey opinions among younger adults

BACKGROUND

Use of companion robots may reduce older people's depression, loneliness and agitation. This benefit has to be contrasted against possible ethical concerns raised by philosophers in the field around issues such as deceit, infantilisation, reduced human contact and accountability. Research directly assessing prevalence of such concerns among relevant stakeholders, however, remains limited, even though their views clearly have relevance in the debate. For example, any discrepancies between ethicists and stakeholders might in itself be a relevant ethical consideration while concerns perceived by stakeholders might identify immediate barriers to successful implementation.

METHODS

We surveyed 67 younger adults after they had live interactions with companion robot pets while attending an exhibition on intimacy, including the context of intimacy for older people. We asked about their perceptions of ethical issues. Participants generally had older family members, some with dementia.

RESULTS

Most participants (40/67, 60%) reported having no ethical concerns towards companion robot use when surveyed with an open question. Twenty (30%) had some concern, the most common being reduced human contact (10%), followed by deception (6%). However, when choosing from a list, the issue perceived as most concerning was equality of access to devices based on socioeconomic factors (m = 4.72 on a scale 1-7), exceeding more commonly hypothesized issues such as infantilising (m = 3.45), and deception (m = 3.44). The lowest-scoring issues were potential for injury or harm (m = 2.38) and privacy concerns (m = 2.17). Over half (39/67 (58%)) would have bought a device for an older relative. Cost was a common reason for choosing not to purchase a device.

CONCLUSIONS

Although a relatively small study, we demonstrated discrepancies between ethical concerns raised in the philosophical literature and those likely to make the decision to buy a companion robot. Such discrepancies, between philosophers and 'end-users' in care of older people, and in methods of ascertainment, are worthy of further empirical research and discussion. Our participants were more concerned about economic issues and equality of access, an important consideration for those involved with care of older people. On the other hand the concerns proposed by ethicists seem unlikely to be a barrier to use of companion robots.

Perspectives on usability and accessibility of an autonomous humanoid robot living with elderly people

PURPOSE

The aim of this study was to assess how cohabitation with a social robot for seven days night and day is perceived by elderly potential users and to suggest technological improvements for future home integration.

METHODS

Fifteen participants were invited to interact with Pepper^®, 24 h a day and 7 days a week. Perceived utility assessment was achieved using a dedicated questionnaire. Usability assessment was carried out by measuring satisfaction with the human-robot interaction and listing malfunctions.

RESULTS

Seventy-eight tasks out of 115 tasks were reported respectively as very high and high. On day 1, satisfaction was at its higher level with a mean of 6.8. On day 8, it maintained at 6.0 despite technical malfunctions and failures, listed with details in this paper. Acceptability was positive. Pepper was mainly considered as an assistant and a link with family and friends and never as an enemy or intruder. Pepper has proven to be potentially able to meet five needs: making the person's environment safe by alerting contact persons, reminding the user of health-related tasks, enabling "doubt removal", maintaining social relationships and following the user.

CONCLUSIONS

Pepper is more than a "demonstration" device classified as level 6 of the nine-point Technology Readiness Level (TRL) scale for the hard and software and level 5 in behavioural terms. Once the technological locks and malfunctions have been overcome, Pepper should be applicable in the home, allowing users to test it in a more familiar environment.Implications for RehabilitationPepper, a humanoid robot, has been perceived as rich in potentialities that can help and secure a fragile person.Following this experience of cohabitation with a humanoid robot, the participants were unanimous in thinking that assistive robotics is the future.To be useful, the robot's people tracking function must inevitably be improved.Pepper, the first humanoid robot ever marketed, is more than just a "demonstration"device, classified at level 6 of Technological Readiness Levels (TRL) for supporting hardware and software and level 5 in terms of behavior.

Designing Socially Assistive Robots for Alzheimer's Disease and Related Dementia Patients and Their Caregivers: Where We are and Where We are Headed

Over the past few years there has been a large rise in the field of robotics. Robots are being in used in many industries, but there has not been a large surge of robots in the medical field, especially the robots for healthcare use. However, as the aging population keeps growing, current medical staff and healthcare providers are increasingly burdened by caring for the ever-growing number of senior patients, especially those with cognitive impairment of Alzheimer's disease (AD) and Alzheimer's disease-related dementia (ADRD) patients. As a result, we can expect to see a large increase in the field of medical robotics, especially in forms of socially assistive robots (SARs) for senior patients and healthcare providers. In fact, SARs can alleviate AD and ADRD patients and their caregivers' unmet medical needs. Herein, we propose a design outline for such a SAR, based on a review of the current literature. We believe the next generation of SARs will enhance health and well-being, reduce illness and disability, and improve quality of life for AD and ADRD patients and their caregivers.

Overcoming Alzheimer's Disease Stigma by Leveraging Artificial Intelligence and Blockchain Technologies

Alzheimer's disease (AD) imposes a considerable burden on those diagnosed. Faced with a neurodegenerative decline for which there is no effective cure or prevention method, sufferers of the disease are subject to judgement, both self-imposed and otherwise, that can have a great deal of effect on their lives. The burden of this stigma is more than just psychological, as reluctance to face an AD diagnosis can lead people to avoid early diagnosis, treatment, and research opportunities that may be beneficial to them, and that may help progress towards fighting AD and its progression. In this review, we discuss how recent advents in information technology may be employed to help fight this stigma. Using artificial intelligence (AI) technologies, specifically natural language processing (NLP), to classify the sentiment and tone of texts, such as those of online posts on various social media sites, has proven to be an effective tool for assessing the opinions of the general public on certain topics. These tools can be used to analyze the public stigma surrounding AD. Additionally, there is much concern among individuals that an AD diagnosis, or evidence of pre-clinical AD such as a biomarker or imaging test results, may wind up unintentionally disclosed to an entity that may discriminate against them. The lackluster security record of many medical institutions justifies this fear to an extent. Adopting more secure and decentralized methods of data transfer and storage, and giving patients enhanced ability to control their own data, such as a blockchain-based method, may help to alleviate some of these fears.

Exploring the perceptions of people with dementia about the social robot PARO in a hospital setting

New technology, such as social robots, opens up new opportunities in hospital settings. PARO, a robotic pet seal, was designed to provide emotional and social support for older people with dementia. We applied video-ethnographic methods, including conversational interviews and observations with video recording among 10 patient participants while they were using the robot. We also conducted semi-structured individual interviews and focus groups with nursing staff to gain contextual information. Patient and family partners were actively involved in the study as co-researchers. This study reports our findings on the perceptions of 10 patients with dementia about their experiences with PARO in a hospital setting. Thematic analysis yielded three substantive themes: (a) ‘it’s like a buddy’ – the robot helps people with dementia uphold a sense of self in the world, (b) ‘it’s a conversation piece’ – the baby seal facilitates social connection and (c) ‘it makes me happy’ – PARO transforms and humanizes the clinical setting. Our findings help provide a better understanding of the perspectives of patients with dementia on the use of social robots.

How people with dementia perceive a therapeutic robot called PARO in relation to their pain and mood: A qualitative study

BACKGROUND

Interacting with social robots, such as the robotic seal PARO, has been shown to improve mood and acute pain for people with dementia. Little attention has been paid to the effect of PARO on people with dementia and chronic pain.

OBJECTIVE

To explore how people with mild to moderate dementia and chronic pain perceive PARO as an alternative intervention to manage their pain and mood.

DESIGN

A descriptive qualitative approach nested within a pilot randomised controlled trial.

METHODS

Participants with dementia and chronic pain were recruited from three residential aged care facilities. They interacted with PARO for 30 min, 5 days a week over a 6-week period. A sample of 11 participants completed individual semi-structured interviews at the end of the intervention. Data were collected from January 2018-January 2019. Inductive thematic analysis was undertaken. Reporting of findings followed the COREQ checklist.

RESULTS

Four themes emerged from the data: (a) perceptions of PARO; (b) therapeutic effects of PARO; (c) limitations of PARO; and (d) programme improvement. Residents with dementia expressed positive attitudes towards the use of PARO and acknowledged the therapeutic benefits of PARO on mood improvement and relaxation for pain relief but also mentioned the limitations of its weight, voice and characteristics. Residents' responses could also fluctuate during the intervention process, and individual preferences need to be considered.

CONCLUSIONS

The PARO intervention is a promising intervention to improve positive emotion, and there is some anecdotal evidence that pain may be decreased from the perspectives of people living with chronic pain and dementia.

RELEVANCE TO CLINICAL PRACTICE

Long-term care staff may incorporate PARO therapy into daily dementia care. Understanding of individual's preferences may enhance the implementation of PARO for pain management in this group.

Companion robots for older people: importance of user-centred design demonstrated through observations and focus groups comparing preferences of older people and roboticists in South West England

OBJECTIVE

Companion robots, such as Paro, may reduce agitation and depression for older people with dementia. However, contradictory research outcomes suggest robot design is not always optimal. While many researchers suggest user-centred design is important, there is little evidence on the difference this might make. Here, we aimed to assess its importance by comparing companion robot design perceptions between older people (end users) and roboticists (developers).

DESIGN

Older people and roboticists interacted with eight companion robots or alternatives at two separate events in groups of two to four people. Interactions were recorded, participants' comments and observations were transcribed, and content was analysed. Subsequently, each group participated in focus groups on perceptions of companion robot design. Discussions were recorded and transcribed, and content was analysed.

PARTICIPANTS AND SETTINGS

Seventeen older people (5 male, 12 female, ages 60-99) at a supported living retirement complex, and 18 roboticists (10 male, 8 female, ages 24-37) at a research centre away-day.

RESULTS

We found significant differences in design preferences between older people and roboticists. Older people desired soft, furry, interactive animals that were familiar and realistic, while unfamiliar forms were perceived as infantilising. By contrast, most roboticists eschewed familiar and realistic designs, thinking unfamiliar forms better suited older people. Older people also expressed desire for features not seen as important by developers. A large difference was seen in attitude towards ability to talk: 12/17 (71%) older people but only 2/18 (11%) roboticists requested speech. Older people responded positively towards life-simulation features, eye contact, robot personalisation and obeying commands, features undervalued by roboticists. These differences were reflected in preferred device, with 'Joy for All' cat chosen most often by older people, while roboticists most often chose Paro.

CONCLUSION

The observed misalignment of opinion between end users and developers on desirable design features of companion robots demonstrates the need for user-centred design during development.

Assistive robots for socialization in elderly people: results pertaining to the needs of the users

BACKGROUND/AIM

Technological solutions can support the elderly, improve their quality of life and reduce isolation and loneliness. The Euro-Japan ACCRA (Agile Co-Creation for Robots and Aging) project has the objective of building a reference co-creation methodology for the development of robotic solutions for ageing. The aim of this study is to provide a pilot qualitative analysis of the real needs of elderly people and their caregivers when exposed to conversational activities with robots and to identify priority needs that should be developed from end-user perspectives.

METHODS

A qualitative research design was adopted to define a pre-structured questionnaire that was administered to the elderly taking part in the piloting sessions. Three groups of end-users were included: subjects with an age ≥ 60 years, informal caregivers and formal caregivers.

RESULTS

The interviews were carried out in Italy and Japan. A total of 17 elderly and 36 caregivers were recruited. Common needs in the two sites were categorized into 3 groups: Communication; Emotion Detection and Safety. General robot acceptance level is good and perception is positive among participants in the pilot sites.

CONCLUSION

A positive perception of the elderly on the application of a robotic solution was found and many are the needs that could be addressed by an appropriate and careful robotic development taking into account the real needs and capabilities of the involved subjects.

Novel Technological Solutions for Assessment, Treatment, and Assistance in Mild Cognitive Impairment

Alzheimer's disease, and dementia, represent a common cause of disability and one of the most relevant challenges in the health world. In addition, these conditions do not have, at moment, a pharmacological treatment that can stop the pathological progress. Mild cognitive impairment (MCI), defined as the borderline between normal aging and early dementia, represents a meaningful field of study because, in the transition to dementia, clinicians have defined a useful therapeutic window. Additionally, due to the lack of effective pharmacological interventions, recent years have seen an increase in research into new technological solutions to assess, stimulate, and assist patients afflicted with Alzheimer's disease. This review aims to outline the use of information and communication technologies in the field studying MCI. Particularly, the goal is to depict the framework and describe the most worthwhile research efforts, in order to display the current technologies available, describe the research objectives, and delineate prospective future researches. Regarding data sources, the research was conducted within three databases, PubMed Central, Web of Science, and Scopus, between January 2009 and December 2017. A total of 646 articles were found in the initial search. Accurate definition of the exclusion criteria and selection strategy allowed identification of the most relevant papers to use for the study. Finally, 56 papers were fully evaluated and included in this review. Three major clinical application areas have been portrayed, namely “Cognitive Assessment,” “Treatment,” and “Assistance.” These have been combined with three main technological solutions, specifically “Sensors,” “Personal Devices,” and “Robots.” Furthermore, the study of the publications time series illustrates a steadily increasing trend, characterized by the enrollment of small groups of subjects, and particularly oriented to the subjects assistance using robots companion. In conclusion, despite the new technological solutions for people with MCI have received much interest, particularly regarding robots for assistance, nowadays it still owns vast room for improvement.

Needs of people with dementia and their informal caregivers concerning assistive technologies

Background and objective: Assistive technologies might be a suitable option for supporting people with dementia and their informal caregivers. To avoid "one-fits-all"-solutions and to design useful technologies, it is essential to consider the end-users' needs. The objective of this review was to examine the needs of people with dementia and their informal caregivers with regard to assistive technologies. Methods: We conducted a scoping review based on a comprehensive literature search in databases, handsearching, and free web searching. Additionally, we performed citation tracking of included studies. We included all types of study designs. Two researchers independently selected the studies. The results were thematically categorised by two researchers. Results: The search yielded 7160 references. 18 of 24 included studies were qualitative. The studies had been conducted in 13 different countries, mostly in Europe. The sample size ranged between two and 270 participants. Most of the studies involved people with dementia as well as informal caregivers. The analysis resulted in eleven themes. The themes could be assigned to three domains: "needed technologies", "characteristics of needed technologies", and "information about technologies". Conclusions: The results might guide future usage, development and research addressing end users' needs with regard to assistive technologies.

Towards a Holistic Approach to Studying Human-Robot Interaction in Later Life

Background and Objectives

Implementation of robotics technology in eldercare depends on successful human-robot interaction (HRI). Relying on a systematic literature review, this article proposes a holistic approach to the study of such interaction.

Research Design and Methods

A literature search was carried out in five databases. A Boolean phrase search included the term robot and at least one term referencing older age, leading to an initial corpus of 543 articles. Articles were included in this review if they described older adults' interaction with robots. Exclusion of articles that did not meet this criterion, as well as duplicate material, led to a total of 80 articles, that were then subjected to quantitative and qualitative analyses.

Results

Studies tended to focus on older users, typically community-dwelling adults, without sufficient consideration of the users' characteristics and the physical, social, and cultural context of the HRI. Using a variety of methods, many studies were snapshot inquiries. The chief topics explored were use patterns, the resulting outcomes thereof and factors that constrain use. Commonly, however, these topics were examined separately. In addition, most studies lacked any theoretical framework.

Discussion and Implications

Additional studies are needed to more fully understand what makes HRI successful. The model presented here suggests scholars to conduct theory-driven research, and distinguish among various segments of older users, different types of robots, and group and individual HRI. It also proposes paying greater attention to the users' cultural, physical and social environment, and application of longitudinal and simultaneous examination of uses, outcomes, and constraints.

Acceptance and Use of Innovative Assistive Technologies among People with Cognitive Impairment and Their Caregivers: A Systematic Review

Cognitive impairments (CI), associated with the consequences of Alzheimer's disease and other dementias, are increasingly prevalent among older adults, leading to deterioration in self-care, mobility, and interpersonal relationships among them. Innovative Assistive Technologies (IAT) such as electronic reminders and surveillance systems are considered as increasingly important tools to facilitate independence among this population and their caregivers. The aim of this study is to synthesise knowledge on facilitators and barriers related to acceptance of and use of IAT among people with CI and their caregivers. This systematic review includes original papers with quantitative, qualitative, or mixed methods design. Relevant peer-reviewed articles published in English between 2007 and 2017 were retrieved in the following databases: CINAHL; PubMed; Inspec; and PsycINFO. The Mixed Method Appraisal Tool (MMAT) was used for quality assessment. We retrieved thirty studies, including in total 1655 participants from Europe, USA/Canada, Australia, and Asia, enrolled in their homes, care-residences, day-care centres, or Living Labs. Two-thirds of the studies tested technologies integrating home sensors and wearable devices for care and monitoring CI symptoms. Main facilitators for acceptance and adherence to IAT were familiarity with and motivation to use technologies, immediate perception of effectiveness (e.g., increase in safety perceptions), and low technical demands. Barriers identified included older age, low maturity of the IAT, little experience with technologies in general, lack of personalization, and support. More than 2/3 of the studies met 80% of the quality criteria of the MMAT. Low acceptance and use of IAT both independently and with caregivers remains a significant concern. More knowledge on facilitators and barriers to use of IAT among clients of health care and social services is crucial for the successful implementation of innovative programmes aiming to leverage innovative technologies for the independence of older people with CI.

Robotic Services Acceptance in Smart Environments With Older Adults: User Satisfaction and Acceptability Study

BACKGROUND

In Europe, the population of older people is increasing rapidly. Many older people prefer to remain in their homes but living alone could be a risk for their safety. In this context, robotics and other emerging technologies are increasingly proposed as potential solutions to this societal concern. However, one-third of all assistive technologies are abandoned within one year of use because the end users do not accept them.

OBJECTIVE

The aim of this study is to investigate the acceptance of the Robot-Era system, which provides robotic services to permit older people to remain in their homes.

METHODS

Six robotic services were tested by 35 older users. The experiments were conducted in three different environments: private home, condominium, and outdoor sites. The appearance questionnaire was developed to collect the users' first impressions about the Robot-Era system, whereas the acceptance was evaluated through a questionnaire developed ad hoc for Robot-Era.

RESULTS

A total of 45 older users were recruited. The people were grouped in two samples of 35 participants, according to their availability. Participants had a positive impression of Robot-Era robots, as reflected by the mean score of 73.04 (SD 11.80) for DORO's (domestic robot) appearance, 76.85 (SD 12.01) for CORO (condominium robot), and 75.93 (SD 11.67) for ORO (outdoor robot). Men gave ORO's appearance an overall score higher than women (P=.02). Moreover, participants younger than 75 years understood more readily the functionalities of Robot-Era robots compared to older people (P=.007 for DORO, P=.001 for CORO, and P=.046 for ORO). For the ad hoc questionnaire, the mean overall score was higher than 80 out of 100 points for all Robot-Era services. Older persons with a high educational level gave Robot-Era services a higher score than those with a low level of education (shopping: P=.04; garbage: P=.047; reminding: P=.04; indoor walking support: P=.006; outdoor walking support: P=.03). A higher score was given by male older adults for shopping (P=.02), indoor walking support (P=.02), and outdoor walking support (P=.03).

CONCLUSIONS

Based on the feedback given by the end users, the Robot-Era system has the potential to be developed as a socially acceptable and believable provider of robotic services to facilitate older people to live independently in their homes.

When robots care: Public deliberations on how technology and humans may support independent living for older adults

While assistive robots receive growing attention as a potential solution to support older adults to live independently, several scholars question the underlying social, ethical and health policy assumptions. One perplexing issue is determining whether assistive robots should be introduced to supplement caregivers or substitute them. Current state of knowledge indicates that users and caregivers consider that robots should not aim to replace humans, but could perform certain tasks. This begs the question of the nature and scope of the tasks that can be delegated to robots and of those that should remain under human responsibility. Considering that such tasks entail a range of actions that affect the meaning of caregiving and care receiving, this article offers sociological insights into the ways in which members of the public reason around assistive actions, be they performed by humans, machines or both. Drawing on a prospective public deliberation study that took place in Quebec (Canada) in 2014 with participants (n = 63) of different age groups, our findings clarify how they envisage what robots can and cannot do to assist older people, and when and why delegating certain tasks to robots becomes problematic. A better understanding of where the publics draw a limit in the substitution of humans by robots refocuses policymakers' attention on what good care entails in modern healthcare systems.